Can an overdose of Coumadin and Lovenox kill a person?

Question

My 79 year old grandmother went to the hospital with pneomonia and was dead within a week. First she was given an antibiotic for the pnemonia which thickened her blood. She was then given coumadin and lovenox to thin her blood. When it got way too thin and they discovered blood pooling in her abdomen, they gave her vitamin k...but it was too late I guess. She stopped breathing and her heart stopped. She was ressusitated and keep on life support for almost 2 days before she passed. (Her ressusitation took between 20-25 minutes, so she was presummed to be brain dead). Is all of this sound normal or was a MAJOR mistake made at the hospital?

She had quadruple bipass surgery years ago and had an artifical heart valve.

"Lovenox would have been stopped as soon as the coumadin reached theraputic dosages. Also neither the pneumonia nor the antibiotics caused her blood the thicken. Most pneumonia in older people are caused by the heart."

Thanks everyone! Guess I should clarify some things. She was already on Coumadin before and during the Lovenox injections. The doctors said the anitbiotics/antigens (?), whatever they gave her for the pnemonia was what caused her blood to get so think. She had viral pnemonia...if that makes any difference.

Also, she was not able to go to surgery for the blood pooling until her blood was thicker. That's why they were giving her the vitamin k to "correct" the way too thin blood.

Thanks again everyone for your responses!
Re:"if I had a patient with an elevated INR who was bleeding, in addition to vitamin K I would also give blood and FFP, the fact that they gave only vitamin K suggests that there was no active bleeding (that they found or suspected) going on at the time."

I forgot to mention that she was recieving blood transfusions as well as the vitamin k. I'm not sure what FFP is, so I don't know if she got that or not. Her INR went from normal to 14 I think from the late night check to the early morning check. As far as doing an ultrasound/CT, they told us she was not stable enough to move from the critical care unit to do those tests or to do surgery. (She had not actually had any surgery during this visit...but she did have catarac surgery a week or two before all of this.)

*Correction* My mom says my grandmother's INR was at 44 (not 14).

Answer 1

Thank you cowboy, because much of what was said above is crap. Oh yeah and they really didn't address the question.

You asked does this sound normal or was there a major mistake?

Although, we strive for better outcomes, sometimes things like this happen. It does not sound like any mistake was made.

I have sen this happen a number of times. All medications behave slightly different for every patient. The blood thinner lovenox works stronger in some than it does in others. There is no good test to tell just how strong an affect lovenox is having. There's a little working in the dark with this medication. Sometimes a change in kidney function can cause the levels to build up too high. Often times the cause is never found. But a rare and low percent of people given lovenox will have serious bleeds. Notabley retroperitoneal hematoma and intracranial bleed. So there's the situation, with an artificial [mechanical] valve you need blood thinners or you are likely to get a serious stroke, but the treatment is not without risk. Don't forget even driving a car has risk involved. IT SOUNDS LIKE A RARE AND UNFORTUNATE SIDE EFFECT FROM THE TREATMENT. But if 9/10 docs would have given the same treatment, than no its not a mistake and by definition its not malpractice.

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OK all the other crap people were stating above...
1) You really cannot overdose on these medications, they are not poisonous.
2) Yes people use coumadin as "rat poison". The rat does not eat it and die from poison,... they get hurt banged up just like you in every day life and they have uncontrolled bleeding that kills them.
3) Pneumonia can 'thicken' the blood. Pneumonia in older people often times leads to systemic inflammatory response. By defeinition the cytokine cascade causes a hypercoagulable state.
4) Pneumonia is not caused by the heart. Passive congestion or edema is not infection. Infection is infection. You dont treat pneumonia with lasix do you, or are you a PCC doc?
5) You ALWAYS try to correct coagulopathies before going to the OR. Only tamponade or intracranial hemorrhage will kill you. 'Internal bleeding' is managed medically each and every day of the week.
6) Bleeding doesn't kill you. You need blood to live, but as long as it keeps being transfused you do all right.

I'm very sorry you lost your grandmother. Some of the sentiment above does have a point. Pneumonia itself is a leading cause of death in older people, they often times just don't have the physiologic reserve or immunocompetency to fight it off. And with coronary disease her chances might not have been that good. Sorry.

Answer 2

Please accept my condolences. An overdose of coumadin and lovenox can kill anyone. I am wondering if the hospital was closely monitoring your grandmother's PT/INR, and PTT. Coumadin and lovenox thin the blood- both have different actions, but coumadin more importantly has to be closely monitored. If the INR is too high, patients can bleed anywhere- mostly internally. Although vitamin K is the antidote for coumadin- fresh frozen plasma is also helpful. I am also questioning the cause of your grandmother's death- did she have a CT scan of her chest and abdomen- this almost sounds like an acute aortic aneurysm, although if the INR levels were not monitored closely, perhaps she had an ulcer that was bleeding uncontrollably. I would question the hospital's care, especially if the INR was really high. Please obtain a copy of her chart. The INR is not supposed to be greater than 3. She should have been on some type of blood thinner if she's had heart valve replacement, but sometimes they put people on more to reduce chances of blood clots in people who are bed bound d/t illness or if people are obese. Her bleeding is a possiblility, but I still would look at the chart to see what was going on- there still are chances for mistakes by the hospital
You also mentioned surgery - what type of surgery? She could have died from complications from that -

Answer 3

I am so sorry to hear about your loss...

Hopefully, my post will help clarify a few issues...

Now, your grandmother absolutely required a theraputic INR as she had a valve replacement (I'll assume that it was a mitral valve, as that would make the story make sense). Any time with a subtheraputic INR would put her at an extremely high risk of clot and stroke.

Antibiotics (especially the fluroquinolones, a popular medication for pneumonia) can interact with coumadin and lower the INR. Lovenox is sort-of an "instant anti-coagulant" and covers the times when the INR was low and your grandmother was at risk for stroke. Lovenox does not change the INR.

The coumadin was likely increased to overcome the interaction with the antibiotics. Once a person is in an ICU, it is difficult to account for all the factors that change the metabolism of coumadin. With frequent monitoring, coumadin dosing is changed... add a little more coumadin if it is low and give a little vitamin K if it is high.

As for the blood pooling in the abdomen? It is hard to say what initiated this... Her increased INR would make it easier for her to bleed, however she could have had a number of factors which led to this.

Does the story sound "normal"? A death never sounds normal, but what you are describing does occur. It sounds like your grandmother was a very complicated patient and it sounds like the medical team tried very hard to revive her.

Again, I am sorry to hear about your loss.

Answer 4

Lovenox And Coumadin

Answer 5

Dont let these other answers fool you.Most of them are crap answers.I had quadruple bipass and an artifical heart valve installed in 1997.I have to take coumadin every day for the rest of my life.I had been taking 6mg and changed docs and he up my meds to 7mg a day.I took that for about 3 wks and started bleeding inside lining of my stomach.I ended up in hospital had to have 2 full syringes of vitamin k and 4 pints of blood.I was a hair from dying.I would say you have a case for malpractice.If she was on coumadin they have to do what is called a Protime test.That tells you how thin or thick your blood is.Your protime count should be between 2.50 and 3.50.Id talk to a medical malpractice attorney and see if you have a case.If you can print this out and take with or copy it down and take with.If you need any more info e-mail me at [e-mail] this helped

Answer 6

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RE:
Can an overdose of Coumadin and Lovenox kill a person?
My 79 year old grandmother went to the hospital with pneomonia and was dead within a week. First she was given an antibiotic for the pnemonia which thickened her blood. She was then given coumadin and lovenox to thin her blood. When it got way too thin and they discovered blood pooling in her...

Answer 7

Sorry about your loss. But lovenox and coumadin are often give together. not to make the blood twice as thin, but lovenox or heparin thins the blood quickly the coumadin take time and must be adjusted over several days with lab test to determine dosage. As the work on different factors the do not have a synergistic effect. More like a relay race. lovenox quickly thinned the blood and handed the long term therapy to coumadin. Lovenox would have been stopped as soon as the coumadin reached theraputic dosages. Also neither the pneumonia nor the antibiotics caused her blood the thicken. Most pneumonia in older people are caused by the heart. I know that sounds crazy, but the heart is a pump when it begins to fail fluid backsup into the lungs. This provides an idea place for infection. Realistically 79 y/o she was already on borrowed time. Again sorry for your lose. Also you can overdose on coumadin or warfarin it is the active ingrediant in rat poison

Answer 8

It's hard to say exactly what went on without knowing more about the situation, however, the danger of an overdose of coumadin or lovenox is, as one might expect, bleeding, and from your description of what was done, it does not sound like your grandmother died of blood loss, if I had a patient with an elevated INR who was bleeding, in addition to vitamin K I would also give blood and FFP, the fact that they gave only vitamin K suggests that there was no active bleeding (that they found or suspected) going on at the time. However, I have difficulty reconciling this with their finding of blood in the abdominal cavity (what they probably found is fluid by ultrasound or CT, which is not blood in most cases).
So I can't really comment on the appropriateness of the medical care she received, at least not with that amount of information, but I can say that it can often be difficult in a hospitalized patient to achieve the right amount of anticoagulation, and that overshooting and undershooting are common initially. Also, when elderly, sick patients are hospitalized, often even with the best of care the result isn't what we would like it to be.

Answer 9

Yes, they can. I have been on coumadin for the last 5 years. Every month they take a little blood to do a PT/INR test. What it does is test how quickly your blood clots. For therapeutic benefit they like that number to be between 2-3 and no higher. Anything higher than that can result in nonstop bleeding from the slightest thing. You could bleed to death from something as simple as cutting yourself while cooking if the blood cannot clot. The normal course is to give vitamin k to counteract the blood-thinning affect of those drugs. The highest mine ever got was 12. I should have been in the hospital, but they just told me to stop and checked me two days later. My mom died after she developed pneumonia and was in the hospital, but she died because she bled to death, not because of the pneumonia. Her blood was too thin because of the coumadin and there was nothing they could do to make her clot fast enough.

Answer 10

Coumadin is a nice name for the rat poison warfarin. It kills rats by internal bleeding. Its used as an anti-coagulant in humans. My father was given coumadin, developed severe headaches, required brain surgery, and lived mostly in bed another 8 years. He had been sprightly and energetic before that.

http://en.wikipedia.org/wiki/Warfarin

Sometimes its nicer to just let someone elderly pass away with dignity at home.